| NPI | 1497057319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-20025) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 7992) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2020-02-04 |